GM retirees face health insurance adjustment

JANESVILLE  Paying for 20 percent of a routine office visit at Dean Clinic-Janesville East is one thing.

Reaching into your pocket to pay 20 percent of an expensive procedure at the neighboring St. Mary's Janesville Hospital is quite another.

That will soon become a consideration for local General Motors' retirees.

Since 2008, Dean and St. Mary's Hospital in Madison have been non-participating health systems in the Medicare supplement offered GM retirees through the UAW Retiree Medical Benefits Trust.

The trust provides health care benefits for more than 860,000 retired UAW members of General Motors, Ford and Chrysler and their eligible dependents.

Launched in January 2010, the trust is a result of the 2007 collective bargaining agreements that transferred all retiree health care liabilities to an independent, voluntary, employee beneficiary association. Although the trust administers the health care plans covering retirees from all three auto companies, there is a separate trust fund that pays benefits for retirees from each auto company.

Effective Jan. 1, the trust will not provide coverage for elective services at non-participating providers.

While Dean and St. Mary's are still on that list, there's a twist for local retirees to consider: St. Mary's Janesville Hospital will open on Jan. 9, and that's where Dean physicians will treat their hospitalized patients.

In the past, the trust paid for the services and procedures for Dean patients at Mercy Hospital and Trauma Center, which is a covered provider.

With the opening of the new St. Mary's hospital, however, the trust will not cover services there because it is a non-participant.

That doesn't mean retirees can't continue to visit Dean or St. Mary's. If they do, however, they will continue to pay what Medicare doesn't cover.

"The real change is with the opening of the new hospital," said Diane Wilhelm, Dean's clinic administrator for Janesville, Delavan and Stoughton. "Mercy, which is an in-network hospital, was the only hospital in town. Our procedures will now be done at the new St. Mary's instead of at Mercy."

The trust has sent mailings to retirees notifying them of the change. Union benefit representatives also met with retirees to explain what will happen with the opening of the new hospital.

But many remain unaware of the change and its implications, said Joan Wilson, the spouse of a local GM retiree.

"People need to be aware of this change," Wilson said, noting that information and mailings talk about "non-participating" providers but do not mention the providers specifically.

Wilson said she and her husband have expensive health issues, but they've decided to stay with Dean and St. Mary's.

"It's because we have a lot of trust and confidence with Dean and St. Mary's," she said. "We like Mercy, and we've been there several times, but we just want to stay with what we've had."

To do that, the Wilsons have signed up for DeanCare Gold, a Medicare insurance plan that will cover their costs for Dean and St. Mary's services.

Wilson said the third layer of coverageóbehind Medicare and the UAW trustówill cost the couple an additional $2,500, but she said it allows them to stay with their doctors and avoid paying 20 percent of an expensive hospital procedure.

Wilhelm said local demand has been high among retirees for the DeanCare product. In fact, representatives are planning more informational meetings in Janesville.

In addition, she said, Dean has been calling local retirees who have procedures scheduled at the new hospital to make sure they understand that their insurance will treat the procedure differently than if it had been done at Mercy.

"We want to make absolutely sure they understand the change so that there are no surprises," Wilhelm said.